Skip to main content

Advertisement

SpringerLink
Log in

Psychotic experiences and suicidal behavior: testing the influence of psycho-socioenvironmental factors

  • Original Paper
  • Published:
Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Purpose

Research has produced inconsistent results with respect to whether the association between psychotic experiences and suicidal behavior is independent of co-occurring clinical and socioenvironmental factors, despite substantial evidence linking the two phenomena. This study tests whether a comprehensive set of demographic, socioenvironmental, and clinical variables account for the statistical association between psychotic experiences and suicidal behaviors.

Methods

We utilized blocked multivariable logistic regression models to analyze the association between 12-month psychotic experiences and 12-month suicide behaviors (ideation, plan, and attempt) on a subsample (N = 2307) of the National Comorbidity Survey Replication. The models adjusted for socio-demographic characteristics, environmental factors in the form of childhood adversity, mental health service utilization, and psychiatric and substance abuse disorders.

Results

Psychotic experiences were significantly associated with suicidal ideation, even after adjusting for socio-demographics, childhood adversity. However, the significant association between psychotic experiences and suicidal ideation was not robust to the inclusion of mental health service utilization and psychiatric disorders. There was no significant association between psychotic experiences and suicide plan. Psychotic experiences were associated with a significantly increased risk of reporting suicide attempts (OR 6.52; 95% CI 1.36–31.11), even after adjusting for the full set of variables.

Conclusions

Although psychotic experiences were not associated with suicidal ideation after statistical adjustments, psychotic experiences were associated with a significantly increased risk of suicide attempts after the inclusion of common risk factors and co-morbidities. Thus, psychotic experiences should be included in routine psychiatric assessments to identify the individuals most at risk for attempting suicide.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Amrhein V, Greenland S, McShane B (2019) Scientists rise up against statistical significance. Nature 567:305–307

    Article  CAS  Google Scholar 

  2. Bromet EJ, Nock MK, Saha S, Lim CC, Aguilar-Gaxiola S, Al-Hamzawi A, de Girolamo G (2017) Association between psychotic experiences and subsequent suicidal thoughts and behavior: a cross-national analysis from the World Health Organization World Mental Health Surveys. JAMA Psychiatry 74(11):1136–1144

    Article  Google Scholar 

  3. Calkins ME, Moore TM, Satterthwaite TD, Wolf DH, Turetsky BI, Roalf DR, Merikangas KR, Ruparel K, Kohler CG, Gur RC, Gur RE (2017) Persistence of psychosis spectrum symptoms in the Philadelphia Neurodevelopmental Cohort: a prospective 2-year follow-up. World Psychiatry 16:62–76

    Article  Google Scholar 

  4. Crumlish N, Whitty P, Kamali M, Clarke M, Browne S, McTigue O, O'callaghan E (2005) Early insight predicts depression and attempted suicide after 4 years in first-episode schizophrenia and schizophreniform disorder. Acta Psychiatr Scand 112(6):449–455

    Article  CAS  Google Scholar 

  5. DeVylder JE, Lukens EP, Link BG, Lieberman JA (2015) Suicidal ideation and suicide attempts among adults with psychotic experiences: data from the collaborative psychiatric epidemiology surveys. JAMA Psychiatry 72(3):219–225

    Article  Google Scholar 

  6. DeVylder JE, Jahn DR, Doherty T, Wilson CS, Wilcox HC, Schiffman J, Hilimire MR (2015) Social and psychological contributions to the co-occurrence of sub-threshold psychotic experiences and suicidal behavior. Soc Psychiatry Psychiatr Epidemiol 50(12):1819–1830

    Article  Google Scholar 

  7. Fazel S, Wolf A, Palm C, Lichtenstein P (2014) Violent crime, suicide, and premature mortality in patients with schizophrenia and related disorders: a 38-year total population study in Sweden. Lancet Psychiatry 1(1):44–54

    Article  Google Scholar 

  8. Harkavy-Friedman JM, Kimhy D, Nelson EA, Venarde DF, Malaspina D, Mann JJ (2003) Suicide attempts in schizophrenia: the role of command auditory hallucinations for suicide. J Clin Psychiatry 64(8):871–874

    Article  Google Scholar 

  9. Harkavy-Friedman JM, Restifo K, Malaspina D, Kaufmann CA, Amador XF, Yale SA, Gorman JM (1999) Suicidal behavior in schizophrenia: characteristics of individuals who had and had not attempted suicide. Am J Psychiatry 156(8):1276–1278

    CAS  PubMed  Google Scholar 

  10. Hielscher E, Connell M, Lawrence D, Zubrick SR, Hafekost J, Scott JG (2018) Association between psychotic experiences and non-accidental self-injury: results from a nationally representative survey of adolescents. Soc Psychiatry Psychiatr Epidemiol 54:1–10

    Google Scholar 

  11. Hielscher E, DeVylder JE, Saha S, Connell M, Scott JG (2018) Why are psychotic experiences associated with self-injurious thoughts and behaviours? A systematic review and critical appraisal of potential confounding and mediating factors. Psychol Med 48(9):1410–1426

    Article  CAS  Google Scholar 

  12. Honings S, Drukker M, van Nierop M, van Winkel R, Wittchen HU, Lieb R, van Os J (2016) Psychotic experiences and incident suicidal ideation and behaviour: disentangling the longitudinal associations from connected psychopathology. Psychiatry Res 245:267–275

    Article  Google Scholar 

  13. Honings S, Drukker M, Groen R, van Os J (2016) Psychotic experiences and risk of self-injurious behaviour in the general population: a systematic review and meta-analysis. Psychol Med 46(2):237–251

    Article  CAS  Google Scholar 

  14. Hor K, Taylor M (2010) Suicide and schizophrenia: a systematic review of rates and risk factors. J Psychopharmacol 24(4_suppl):81–90

    Article  Google Scholar 

  15. Ishii T, Hashimoto E, Ukai W, Kakutani Y, Sasaki R, Saito T (2014) Characteristics of attempted suicide by patients with schizophrenia compared with those with mood disorders: a case-controlled study in northern Japan. PLoS ONE 9(5):e96272

    Article  Google Scholar 

  16. Kelleher I, Cederlöf M, Lichtenstein P (2014) Psychotic experiences as a predictor of the natural course of suicidal ideation: a Swedish cohort study. World Psychiatry 13(2):184–188

    Article  Google Scholar 

  17. Kelleher I, Corcoran P, Keeley H, Wigman JT, Devlin RH, Wasserman D (2013) Psychotic symptoms and population risk for suicide attempt: a prospective cohort study. JAMA Psychiatry 70(9):940–948

    Article  Google Scholar 

  18. Kelleher I, Devlin N, Wigman JT, Kehoe A, Murtagh A, Fitzpatrick C, Cannon M (2014) Psychotic experiences in a mental health clinic sample: implications for suicidality, multimorbidity and functioning. Psychol Med 44(8):1615–1624

    Article  CAS  Google Scholar 

  19. Kessler RC, Adler LA, Barkley R, Biederman J, Conners CK, Faraone SV, Zaslavsky AM (2005) Patterns and predictors of ADHD persistence into adulthood: results from the National Comorbidity Survey Replication. Biol Psychiatry 5(11):1442–1451

    Article  Google Scholar 

  20. Kessler RC, Barker PR, Colpe LJ, Epstein JF, Ggroerer JC, Hiripi E, Zaslavsky AM (2003) Screening for serious mental illness in the general population. Arch Gen Psychiatry 60:184–189

    Article  Google Scholar 

  21. Kessler RC, Berglund P, Chiu WT, Demler O, Heeringa S, Hiripi E, Zheng H (2004) The US national comorbidity survey replication (NCS-R): design and field procedures. Int J Methods Psychiatr Res 13(2):69–92

    Article  Google Scholar 

  22. Kessler RC, Üstün TB (2004) The World Mental Health (WMH) survey initiative version of the World Health Organization (WHO) composite international diagnostic interview (CIDI). Int J Methods Psychiatr Res 13(2):93–121

    Article  Google Scholar 

  23. Klonsky ED, May AM (2015) The three-step theory (3ST): a new theory of suicide rooted in the “ideation-to-action” framework. Int J Cognit Ther 8(2):114–129

    Article  Google Scholar 

  24. Linscott RJ, Van Os J (2013) An updated and conservative systematic review and meta-analysis of epidemiological evidence on psychotic experiences in children and adults: on the pathway from proneness to persistence to dimensional expression across mental disorders. Psychol Med 43(6):1133–1149

    Article  CAS  Google Scholar 

  25. López-Moríñigo JD, Ramos-Ríos R, David AS, Dutta R (2012) Insight in schizophrenia and risk of suicide: a systematic update. Compr Psychiatry 53(4):313–322

    Article  Google Scholar 

  26. Martin G, Thomas H, Andrews T, Hasking P, Scott JG (2015) Psychotic experiences and psychological distress predict contemporaneous and future non-suicidal self-injury and suicide attempts in a sample of Australian school-based adolescents. Psychol Med 45(2):429–437

    Article  CAS  Google Scholar 

  27. Murphy J, Shevlin M, Hyland P, Christoffersen M, Elklit A, Bentall R (2018) Reconsidering the association between psychosis and suicide: a suicidal drive hypothesis. Psychosis 10(4):286–297

    Article  Google Scholar 

  28. Nishida A, Tanii H, Nishimura Y, Kajiki N, Inoue K, Okada M, Sasaki T, Okazaki Y (2008) Associations between psychotic-like experiences and mental health status and other psychopathologies among Japanese early teens. Schizophr Res 99:125–133

    Article  Google Scholar 

  29. Nock MK, Kessler RC (2006) Prevalence of and risk factors for suicide attempts versus suicide gestures: analysis of the National Comorbidity Survey. J Abnorm Psychol 115(3):616

    Article  Google Scholar 

  30. Rogers P, Watt A, Gray NS, MacCulloch M, Gournay K (2002) Content of command hallucinations predicts self-harm but not violence in a medium secure unit. J Forensic Psychiatry 13(2):251–262

    Article  Google Scholar 

  31. Selten JP, van der Ven E, Rutten BP, Cantor-Graae E (2013) The social defeat hypothesis of schizophrenia: an update. Schizophr Bull 39(6):1180–1186

    Article  Google Scholar 

  32. Shrivastava A, Johnston ME, Shah N, Innamorati M, Stitt L, Thakar M, Pompili M (2010) Persistent suicide risk in clinically improved schizophrenia patients: challenge of the suicidal dimension. Neuropsychiatr Dis Treat 6:633

    CAS  PubMed  PubMed Central  Google Scholar 

  33. Van Orden KA, Witte TK, Cukrowicz KC, Braithwaite SR, Selby EA, Joiner TE Jr (2010) The interpersonal theory of suicide. Psychol Rev 117(2):575

    Article  Google Scholar 

  34. Yates K, Lång U, Cederlöf M, Boland F, Taylor P, Cannon M, Kelleher I (2019) Association of psychotic experiences with subsequent risk of suicidal ideation, suicide attempts, and suicide deaths: a systematic review and meta-analysis of longitudinal population studies. JAMA Psychiatry 76(2):180–189

    Article  Google Scholar 

Download references

Acknowledgements

This research was supported by a young investigator Grant from the American Foundation for Suicide Prevention (Grant YIG-1-042-16 to Dr. DeVylder). Emily Hielscher is supported by the Dr. F and Mrs. ME Zaccari Scholarship, Australia. James Scott is supported by a National Health and Medical Research Council Practitioner Fellowship Grant APP1105807 and is employed by the Queensland Centre for Mental Health Research which receives core funding from Queensland Health.

Author information

Authors and Affiliations

  1. Graduate School of Social Service, Fordham University, New York, NY, 10009, USA

    Jordan DeVylder

  2. Department of Sociology, Harvard University, Cambridge, MA, USA

    Kyle Waldman

  3. Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia

    Emily Hielscher & James Scott

  4. Queensland Centre for Mental Health Research (QCMHR), The Park Centre for Mental Health, Wacol, QLD, Australia

    Emily Hielscher & James Scott

  5. School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia

    Emily Hielscher & James Scott

  6. Metro North Mental Health, Royal Brisbane and Women’s Hospital, Herston, QLD, Australia

    James Scott

  7. Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA

    Hans Oh

Authors
  1. Jordan DeVylder
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kyle Waldman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Emily Hielscher
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. James Scott
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hans Oh
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jordan DeVylder.

Ethics declarations

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 16 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

DeVylder, J., Waldman, K., Hielscher, E. et al. Psychotic experiences and suicidal behavior: testing the influence of psycho-socioenvironmental factors. Soc Psychiatry Psychiatr Epidemiol 55, 1167–1177 (2020). https://doi.org/10.1007/s00127-020-01841-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00127-020-01841-9

Keywords

Search

Navigation